TY  - BOOK
AU  - Chan, Chee Man
AU  - Mitchell, Anthony L
AU  - Shorr, Andrew F
TI  - Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*. [Review]
SN  - 0090-3493
PY  - 2012///
KW  - *Adrenal Insufficiency/ci [Chemically Induced]
KW  - *Anesthetics, Intravenous/ae [Adverse Effects]
KW  - *Etomidate/ae [Adverse Effects]
KW  - *Sepsis/co [Complications]
KW  - *Sepsis/mo [Mortality]
KW  - Aged
KW  - Aged, 80 and over
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Qualitative Research
KW  - Randomized Controlled Trials as Topic
KW  - MedStar Washington Hospital Center
KW  - Medicine/Pulmonary-Critical Care
KW  - Journal Article
KW  - Meta-Analysis
KW  - Review
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - CONCLUSIONS: Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis; DESIGN: A systematic review of randomized controlled trials and observational studies with meta-analysis; INTERVENTIONS: None; MEASUREMENTS AND MAIN RESULTS: We conducted a systematic review of randomized controlled trials and observational studies with meta-analysis assessing the effects of etomidate on adrenal insufficiency and all-cause mortality published between January 1950 and February 2012. We only examined studies including septic patients. All-cause mortality served as our primary end point, whereas the prevalence of adrenal insufficiency was our secondary end point. Adrenal insufficiency was determined using a cosyntropin stimulation test in all studies. We used a random effects model for analysis; heterogeneity was assessed with the I statistic. Publication bias was evaluated with Begg's test. Five studies were identified that assessed mortality in those who received etomidate. A total of 865 subjects were included. Subjects who received etomidate were more likely to die (pooled relative risk 1.20; 95% confidence interval 1.02-1.42; Q statistic, 4.20; I2 statistic, 4.9%). Seven studies addressed the development of adrenal suppression associated with the administration of etomidate; 1,303 subjects were included. Etomidate administration increased the likelihood of developing adrenal insufficiency (pooled relative risk 1.33; 95% confidence interval 1.22-1.46; Q statistic, 10.7; I2 statistic, 43.9%); OBJECTIVE: To evaluate the effects of single-dose etomidate on the adrenal axis and mortality in patients with severe sepsis and septic shock; SETTING: Literature search of EMBASE, Medline, Cochrane Database, and Evidence-Based Medical Reviews; SUBJECTS: Sepsis patients who received etomidate for rapid sequence intubation
UR  - http://dx.doi.org/10.1097/CCM.0b013e31825fec26
ER  -